Provider Demographics
NPI:1912662123
Name:HARVEY, OPHELIA SAM (APRN)
Entity Type:Individual
Prefix:MS
First Name:OPHELIA
Middle Name:SAM
Last Name:HARVEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:OPHELIA
Other - Middle Name:SAM
Other - Last Name:HARVEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:3509 SHAKERTOWN RD
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-2507
Mailing Address - Country:US
Mailing Address - Phone:615-429-5236
Mailing Address - Fax:
Practice Address - Street 1:601 W DUE WEST AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-4423
Practice Address - Country:US
Practice Address - Phone:615-227-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30322363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily